Provider Demographics
NPI:1104119874
Name:DICKERMAN, SHEILA R (PA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:R
Last Name:DICKERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:OBRADOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2546 MIDDLETON GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4784
Mailing Address - Country:US
Mailing Address - Phone:813-781-5233
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH ST STE 2
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2295
Practice Address - Country:US
Practice Address - Phone:207-760-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105799363A00000X
MEPA2079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013054000Medicaid